Factors in Psychiatric Admissions: Before and During the Covid-19 Pandemic.

OBJECTIVE: The COVID-19 pandemic has impacted community mental health, but the effect on psychiatric admissions is unknown. We investigated factors contributing to acute psychiatric admissions, and whether this changed during the first UK lockdown. METHOD: A retrospective case-note review study with an exploratory mixed-methods design to examine factors for psychiatric admissions following the first UK 2020 lockdown compared to the same time periods in 2019 and 2018. RESULTS: Themes of psychopathology, risk, social stressors, community treatment issues, and physical health concerns were generated. The mean number of codes per case was 6.19 (s . d. = 2.43), with a mean number of categories per case of 3.73, (s. d. = 0.98). Changes in routines and isolation were common factors in the study year; accommodation and substance abuse were more prominent in the control year. Relationship stressors featured strongly in both groups. There were significantly more women (χ2(1, N = 98) = 20.80, p < 0.00001) and older adults (χ2(1, N = 98) = 8.61, p = 0.0033) in the study group than the control. Single people, compared to those in a relationship (χ2(1, N = 45) = 4.46, p = 0.035), and people with affective disorders compared to psychotic disorders ((χ2(1, N = 28) = 5.19, p = 0.023), were more likely to have a COVID-19 related admission factor. CONCLUSIONS: Early stages of the COVID-19 pandemic amplified pre-existing psychosocial vulnerabilities with a disproportionate psychiatric admissions impact on the mental health of women, older adults and those with affective disorders.

Ect in Two Elderly Patients with Covid-19: Weighing Up Unknown Risks in Unprecedented Times.

The COVID-19 pandemic has created an unprecedented situation demanding a rapid response to a barrage of unknown risks. Issues around infection control, resource allocation and treatment delivery have threatened the viability and accessibility of Electroconvulsive Therapy (ECT) services. Additionally, there are unquantified risks around the delivery and effect of ECT in patients who have had COVID-19. We discuss two cases where ECT was restarted in older-adults who had had symptomatic COVID-19. We consider the importance of clinical assessment, multi-speciality team involvement, and comprehensive risk assessment in making high stakes treatment decisions around ECT in patients with COVID-19. Although more research and international multi-speciality collaboration is required to develop evidence-based guidance, it is vital that we maintain equitable access to safe, effective and potentially life-saving ECT during this pandemic.